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KEY CLINICAL UPDATES IN RELAPSING POLYCHONDRITIS

Large vessel vasculitis is a frequently overlooked but potentially catastrophic complication.

This disease is characterized by inflammatory destructive lesions of cartilaginous structures, principally the ears, nose, trachea, and larynx. Nearly 40% of cases are associated with another disease, especially either other immunologic disorders (such as SLE, rheumatoid arthritis, or Hashimoto thyroiditis) or cancers (such as plasma cell myeloma) or hematologic disorders (such as myelodysplastic syndrome). The disease, which is usually episodic, affects males and females equally. The cartilage is painful, swollen, and tender during an attack and subsequently becomes atrophic, resulting in permanent deformity. Biopsy of the involved cartilage shows inflammation and chondrolysis. Laryngotracheal and bronchial chondritis can lead to life-threatening airway narrowing and collapse. Noncartilaginous manifestations of the disease include fever, episcleritis, uveitis, deafness, aortic regurgitation, and rarely glomerulonephritis. In 85% of patients, a migratory, asymmetric, and seronegative arthropathy occurs, affecting both large and small joints and the costochondral junctions. Large vessel vasculitis is a frequently overlooked but potentially catastrophic complication. Diagnosing this uncommon disease is especially difficult since the signs of cartilage inflammation (such as red ears or nasal pain) may be more subtle than the fever, arthritis, rash, or other systemic manifestations.

Prednisone, 0.5–1 mg/kg/day orally, is often effective. Dapsone (100–200 mg/day orally) or methotrexate (7.5–20 mg orally per week) may also have efficacy, sparing the need for long-term high-dose corticosteroid treatment. Involvement of the tracheobronchial tree may respond to inhibitors of TNF.

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